Individual provider Active NPI

Maniphab Vongsena, APRN, FNP-BC

  • Family Nurse Practitioner
  • Wichita, KS
National Provider Identifier
1417725391
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
53-82611-081 Issued in KS
Practice address
1261 N Maize Rd
Wichita, KS 67212-4302
Phone
(785) 272-2631
NPI assigned
Dec 19, 2023
Last updated
Oct 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1142373 TX
Family Nurse Practitioner 363LF0000X 53-82611-081 KS Primary

Addresses

Primary practice location

1261 N Maize Rd
Wichita, KS 67212-4302

Mailing address

1261 N Maize Rd
Wichita, KS 67212-4302
Phone (785) 272-2631

Other practice location 1

2600 N Woodlawn Blvd
Wichita, KS 67220-2729
Phone (316) 500-7777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241021001853 KS Practitioner - Nurse Practitioner 6002348653 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergent Care Plus of Overland Park LLCGroup PAC ID 8123153939, 26 clinicians

Practice addresses (Care Compare)

1100 N 4TH St
Leavenworth, KS 66048-1572
Phone (913) 297-9945

1261 N Maize Rd
Wichita, KS 67212-4302
Phone (316) 773-2733

2001 N Rock Rd
Derby, KS 67037-3795
Phone (316) 788-1437

3006 S Seneca St
Wichita, KS 67217-3210
Phone (316) 522-4635

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
53-82611-081KSMDFamily Nurse Practitioner
1142373TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergent Care Plus of Overland Park, LLC CurrentSince Oct 3, 2024 Accepting new patients

Locations

1100 N 4th St
Leavenworth, KS 66048
Phone (913) 297-9945

1261 N Maize Rd
Wichita, KS 67212
Phone (316) 773-2718

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1417725391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1261 N MAIZE RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672124302",
            "telephone_number": "785-272-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1261 N MAIZE RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672124302",
            "telephone_number": "785-272-2631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 N Woodlawn Blvd",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672202729",
            "country_code": "US",
            "telephone_number": "316-500-7777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VONGSENA",
        "first_name": "MANIPHAB",
        "credential": "APRN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-19",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1142373",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-82611-081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.